Abstract Verbal Order Policies, Perceptions and Occurrences Face-to-face verbal and telephone orders (VO) are commonly used in inpatient care settings. VOs hold substantial potential for miscommunication due to a variety of factors, including fatigue, workload, sound-alike medications, background noise, accents, dialects and different pronunciations. VO prescribers and receivers may also misspeak, miscommunicate or not understand patient-specific information being exchanged (e.g., indicating the possible need for an order). These inherent dangers have been recognized by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), the National Quality Forum (NQF) and others. While VOs are commonly used, there has been little systematic study of the strategies and tactics used to ensure their appropriate use, or how to ensure that they are accurately communicated, correctly understood, initially documented and subsequently transcribed into the medical record, or ultimately carried out as intended. The primary aim of this study is to improve understanding of the nature and scope of verbal and telephone order standards of practice, effectiveness of these standards in improving patient care, and estimates of the utilization of verbal and telephone orders in acute care hospitals. Three specific aims will include 1) developing descriptive profiles and a typology of acute care hospitals'inpatient verbal and telephone order policies, strategies, tactics, and specific organizational structures and processes used to govern their use, and to minimize potential errors and adverse events;2) to obtain estimates of inpatient verbal and telephone order frequency and occurrence, based on surveying community hospitals and academic medical centers participating in Specific Aim 1 and 3) gaining insights into key stakeholders'perceived advantages and disadvantages associated with the use of verbal and telephone orders, and explore the extent to which verbal and telephone order policies are followed, and learn how effective such policies are in preventing miscommunications and misunderstandings leading to patient care errors. Study sites will include a stratified sample of acute care hospitals, with a goal of the final sample containing 40 hospitals (i.e., 10 in each of four hospital categories). Analyses will include a diverse combination of qualitative and quantitative analyses of VO related documents, VO utilization statistics, and perceptions of key informants regarding VO utilization in their own institutions. The proposed work will significantly advance the understanding of current verbal order standards of practice, perceived effectiveness of these standards, and develop national estimates for verbal order practices. The long-term goal of this research is to develop evidence- based recommendations for the appropriate, safe and effective use of verbal orders.